876 infection control & hospital epidemiology july 2018, vol. 39, no. 7 Data Analysis
The primary outcome measure was MC removal due to AEs and MC removal due to other reasons (categorical variable). As appro- priate, the χ2 test, the Fisher exact test, and the Mann-Whitney U test were used to detect associations between the variables measured and the rate of AEs. The statistical significance level was set at P<.05. Analyses were performed using R version 3.3.3 statistical software (R Foundation for Statistical Computing, Vienna,Austria).
results
In total, 1,538 (97.1%) patients had an MC removed during the study period. The removal due to AEs was associatedwith a shorter dwell time compared to other reasons, when receiving supportive therapy and when a MC with an open system was inserted (Table 1). Most MCs (n=1,384, 90%) were removed for reasons other than AEs: 719 (52%) for patient death, 586 (42.3%) for termination of therapy, 62 (4.5%) for accidental removal, and 17 for device expiration (1.2%). A significant difference in accidental removals was observed between MCs inserted on the right versus left side (64.9% vs 35.1%; P=.03). The 154 AEs reported accounted for 10% of catheter
removal, corresponding to a complication’s incidence density of 2.49 AEs per 1,000 MC days. The individual AEs experi- enced by patients and time elapsed between MC insertion and the onset of each AE are listed in Table 2.
All Patients (n=1,538)
155 (38.3) 83 (77–88) Valved
Insertion location, no. (%) Left side
Accessed vein Basilic vein Brachial vein Cephalic vein
Administered therapy, no. (%) Supportive therapy Chemotherapy
Dwell time, median d (IQR) Chemotherapy
Supportive therapiesc Open system Valved system
829 (53.9) 709 (46.1)
413 (27.5) 1,281 (83.3)
242 (15.7) 14 (1.0)
1,370 (89.1) 168 (10.9)
26 (12–37) 25.5 (15–32) 26 (11–38) 27 (15–36) 23 (9–39)
discussion
Our findings suggest that MC can be a safe device for medium- term therapy, confirming the findings of a previous systematic review that reported that the risk of BSI was lower among patients with MCs (0.2 per 1,000 catheter days) than those with periph- erally inserted central catheters (2.1 per 1, 000 catheter days) or short-term central venous catheters (2.7 per 1,000 catheter days).3 We found a lower aggregate incidence density of all
complications that those of previous reports3,9; however, we did not include pain and bleeding in the composite outcome, and we considered accidental removal separately. The median MC dwell time (26 days) was in line with CDC guidelines, which recommend the use of a MC for intravenous therapy exceeding 6 days.5 However, our data suggest that this ideal period could be extended up to 273 days without risk of AE occurrence. These findings confirmed a preliminary ret- rospective analysis of 92 home-care patients with advanced cancer, which reported a median MC dwell time of 85 days, ranging up to 1 year.10 Thus, MCs may work successfully even beyond their recommended period of use. This consideration may be particularly important for healthcare professionals because they weigh the risk of leaving aMC in place longer than suggested against the sometimes limited benefit ofmore frequent replacement, especially in patients with limited life expectancy. This study has some shortcomings. First, as with all retrospective studies, there were problems with incomplete
table 1. Patient and Midline Catheter (MC) Characteristics According to Reason for MC Removal: Bivariate Analysis (n=1,538) Variables
MC Removal Due to AEsa (n=154)
Patient characteristics Male gender, no. (%)b Age, median y (IQR)
MC characteristics MC system, n (%) Open
17 (41.5) 83.5 (80–87)
94 (61) 60 (39)
39 (26) 130 (85)
21 (13.7) 2 (1.3)
143 (92.9) 11 (7.1)
14 (6–28) 22 (6–30) 14 (6–28) 13 (6–24) 19 (6–50)
MC Removal for Other Reasons (n=1,384)
138 (37.9) 83 (77–89)
735 (53.1) 649 (46.9)
374 (27.6) 1,151 (83.2)
221 (16) 12 (0.9)
.147
1,227 (88.7) 157 (11.3)
27 (13–37.25) 26 (16–32) 27 (13–40) 29 (17–37) 24 (10–38)
NOTE. AEs, adverse events; IQR, interquartile range. aAEs were defined as ≥1 of the following: occlusion, exit-site infection, or symptomatic thrombosis. bData on 409 patients: 155 male (38%) and 254 female (62%). cSupportive therapies included peripheral parenteral nutrition with osmolarity <600 mOsm/L and hydration.
<.001 .318
<.001 <.001 .493
.745 .675
.784 .915
.074
P Value
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140 |
Page 141 |
Page 142 |
Page 143 |
Page 144
